Pankreas Endokrin Hastalıklarında Cerrahi Tedaviler
Özet
Pankreatik nöroendokrin neoplaziler (PNEN), nadir görülen ve genellikle sporadik olsa da genetik sendromlarla ilişkilendirilebilen tümörlerdir. Bu lezyonlar, hormon salgılayıp salgılamamalarına göre fonksiyonel (insülinoma, gastrinoma, VIPoma vb.) ve non-fonksiyonel olarak ikiye ayrılır. İnsülinoma en sık görülen tür olup genellikle selim seyrederken, glukagonoma ve somatostatinoma gibi türler tanı anında sıklıkla metastatiktir. Cerrahi müdahale PNEN yönetiminde temel tedavi yöntemi olup strateji; tümörün tipine, boyutuna, lokalizasyonuna ve evresine göre belirlenir. 2 cm'den küçük, pankreatik kanalla ilişkisiz düşük gradeli tümörlerde enükleasyon gibi pankreas koruyucu cerrahiler tercih edilebilirken; daha büyük veya invaziv lezyonlarda pankreatikoduodenektomi (Whipple) veya distal pankreatektomi gibi klasik rezeksiyonlar uygulanır. Günümüzde bu prosedürler laparoskopik ve robotik tekniklerle minimal invaziv olarak da gerçekleştirilebilmektedir. Tanı ve evrelemede Ga-68 DOTATATE PET ve EUS gibi gelişmiş görüntüleme yöntemleri ile Ki-67 proliferatif indeksi kritik rol oynar. Metastatik hastalık varlığında dahi semptom kontrolü ve sağkalım avantajı için debulking cerrahisi değerlendirilmelidir.
Pancreatic neuroendocrine neoplasms (PNEN) are rare tumors that are generally sporadic but can be associated with genetic syndromes. These lesions are categorized as functional (insulinoma, gastrinoma, VIPoma, etc.) or non-functional based on whether they secrete hormones. Insulinoma is the most common type and usually follows a benign course, whereas types like glucagonoma and somatostatinoma are often metastatic at the time of diagnosis. Surgical intervention is the primary treatment in PNEN management, with the strategy determined by the tumor's type, size, localization, and stage. For low-grade tumors smaller than 2 cm that are not related to the pancreatic duct, pancreas-preserving surgeries such as enucleation may be preferred; however, for larger or invasive lesions, classic resections like pancreaticoduodenectomy (Whipple) or distal pancreatectomy are performed. Today, these procedures can also be executed minimally invasively using laparoscopic and robotic techniques. Advanced imaging methods like Ga-68 DOTATATE PET and EUS, along with the Ki-67 proliferative index, play a critical role in diagnosis and staging. Even in the presence of metastatic disease, debulking surgery should be considered for symptom control and survival benefit.
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